Shaping, adapting and reserving the right to play: Responding to uncertainty in high quality cassava flour value chains in Nigeria

Purpose: The purpose of this paper is to explain why the high quality cassava flour (HQCF) value chain in Nigeria has not performed as well as expected. The specific objectives are to: analyse important sources of uncertainty influencing HQCF value chains; explore stakeholders’ strategies to respond to uncertainty; and highlight the implications of different adaptation strategies for equity and the environment in the development of the value chain. Design/methodology/approach: The authors used a conceptual framework based on complex adaptive systems to analyse the slow development of the value chain for HQCF in Nigeria, with a specific focus on how key stakeholders have adapted to uncertainty. The paper is based on information from secondary sources and grey literature. In particular, the authors have drawn heavily on project documents of the Cassava: Adding Value for Africa project (2008 to present), which is funded by the Bill & Melinda Gates Foundation, and on the authors’ experience with this project. Findings: Policy changes; demand and supply of HQCF; availability and price of cassava roots; supply and cost of energy are major sources of uncertainty in the chain. Researchers and government have shaped the chain through technology development and policy initiatives. Farmers adapted by selling cassava to rival chains, while processors adapted by switching to rival cassava products, reducing energy costs and vertical integration. However, with uncertainties in HQCF supply, the milling industry has reserved the right to play. Vertical integration offers millers a potential solution to uncertainty in HQCF supply, but raises questions about social and environmental outcomes in the chain. Research limitations/implications: The use of the framework of complex adaptive systems helped to explain the development of the HQCF value chain in Nigeria. The authors identified sources of uncertainty that have been pivotal in restricting value chain development, including changes in policy environment, the demand for and supply of HQCF, the availability and price of cassava roots, and the availability and cost of energy for flour processing. Value chain actors have responded to these uncertainties in different ways. Analysing these responses in terms of adaptation provides useful insights into why the value chain for HQCF in Nigeria has been so slow to develop. Social implications: Recent developments suggest that the most effective strategy for the milling industry to reduce uncertainty in the HQCF value chain is through vertical integration, producing their own cassava roots and flour. This raises concerns about equity. Until now, it has been assumed that the development of the value chain for HQCF can combine both growth and equity objectives. The validity of this assumption now seems to be open to question. The extent to which these developments of HQCF value chains can combine economic growth, equity and environmental objectives, as set out in the sustainable development goals, is an open question. Originality/value: The originality lies in the analysis of the development of HQCF value chains in Nigeria through the lens of complex adaptive systems, with a particular focus on uncertainty and adaptation. In order to explore adaptation, the authors employ Courtney et al.’s (1997) conceptualization of business strategy under conditions of uncertainty. They argue that organisations can assume three strategic postures in response to uncertainty and three types of actions to implement that strategy. This combination of frameworks provides a fresh means of understanding the importance of uncertainty and different actors’ strategies in the development of value chains in a developing country context

Practical lessons on scaling up smallholder-inclusive and sustainable cassava value chains in Africa

Developing more inclusive and sustainable agricultural value chains at scale is a development priority. The ‘Cassava: Adding Value for Africa’ project has supported the development of value chains for high quality cassava flour (HQCF) in Ghana, Tanzania, Uganda, Nigeria, and Malawi to improve the incomes and livelihoods of smallholder households, including women. The project focused on three key interventions: 1) ensuring a consistent supply of raw materials; 2) developing viable intermediaries as secondary processors or bulking agents; and 3) driving market demand. Scaling-up experiences are presented, guided by an analysis of drivers (ideas/models, vision and leadership, incentives and accountability), the enabling context (institutions, infrastructure, technology, financial, policy and regulations, partnerships and leverage, social context, environment), and the monitoring, evaluation, and learning process. Lessons for scaling up of similar value chain interventions are presented. These highlight the tension between rapid development of value chains and achieving equity and sustainability goals; the need for holistic approaches to capacity strengthening of diverse value chain actors; the role of strengthening equitable business relationships and networks as a vital element of scaling processes; and how informed engagement with government policy and regulatory issues is key, but often challenging given conflicting pressures on policymakers. The scaling process should be market-led, but the level and type of public sector and civil society investment needs careful consideration by donors, governments, and others, in particular less visible investments in fostering relationships and trust. Addressing uncertainties around smallholder-inclusive value chain development requires adaptive management and facilitation of the scaling process

The use of formative research to inform the design of a seasonal malaria chemoprevention intervention in northern Nigeria

BACKGROUND:Experience of seasonal malaria chemoprevention (SMC) is growing in the Sahel sub-region of Africa, though there remains insufficient evidence to recommend a standard deployment strategy. In 2012, a project was initiated in Katsina state, northern Nigeria, to design an appropriate and effective community-based delivery approach for SMC, in consultation with local stakeholders. Formative research (FR) was conducted locally to explore the potential feasibility and acceptability of SMC and to highlight information gaps and practical considerations to inform the intervention design. METHODS:The FR adopted qualitative methods; 36 in-depth interviews and 18 focus group discussions were conducted across 13 target groups active across the health system and within the community. Analysis followed the 'framework' approach. The process for incorporating the FR results into the project design was iterative which was initiated by a week-long 'intervention design' workshop with relevant stakeholders. RESULTS:The FR highlighted both supportive and hindering factors to be considered in the intervention design. Malaria control was identified as a community priority, the community health workers were a trusted resource and the local leadership exerted strong influence over household decisions. However, there were perceived challenges with quality of care at both community and health facility levels, referral linkage and supportive supervision were weak, literacy levels lower than anticipated and there was the potential for suspicion of 'outside' interventions. There was broad consensus across target groups that community-based SMC drug delivery would better enable a high coverage of beneficiaries and potentially garner wider community support. A mixed approach was recommended, including both community fixed-point and household-to-household SMC delivery. The FR findings were used to inform the overall distribution strategy, mechanisms for integration into the health system, capacity building and training approaches, supportive interventions to strengthen the health system, and the social mobilization strategy. CONCLUSIONS:Formative research played a valuable role in exploring local socio-cultural contexts and health system realities. Both opportunities and challenges for the introduction of SMC delivery were highlighted, which were appropriately considered in the design of the project

Correction to: Emergence of knock-down resistance in the Anopheles gambiae complex in the Upper River Region, The Gambia, and its relationship with malaria infection in children.

Unfortunately, the original article [1] contained an error mistakenly carried forward by the Production department handling this article whereby some figures and their captions were interchanged. The correct figures (Figs. 1, 2, 3, 4, 5) and captions are presented in this erratum. The original article has also been updated to reflect this correction

Advances in intravesical drug delivery systems to treat bladder cancer

Chemotherapeutic agents administered intravesically to treat bladder cancer have limited efficacy due to periodic dilution and wash-out during urine formation and elimination. This review describes the pathophysiology, prevalence and staging of bladder cancer, and discusses several formulation strategies used to improve drug residence within the bladder. These include the use of amphiphilic copolymers, mucoadhesive formulations, hydrogels, floating systems, and liposomes. Various in vitro and in vivo models recently employed for intravesical drug delivery studies are discussed. Some of the challenges that have prevented the clinical use of some promising formulations are identified

Soft windowing application to improve analysis of high-throughput phenotyping data.

MOTIVATION: High-throughput phenomic projects generate complex data from small treatment and large control groups that increase the power of the analyses but introduce variation over time. A method is needed to utlize a set of temporally local controls that maximizes analytic power while minimizing noise from unspecified environmental factors. RESULTS: Here we introduce \u27soft windowing\u27, a methodological approach that selects a window of time that includes the most appropriate controls for analysis. Using phenotype data from the International Mouse Phenotyping Consortium (IMPC), adaptive windows were applied such that control data collected proximally to mutants were assigned the maximal weight, while data collected earlier or later had less weight. We applied this method to IMPC data and compared the results with those obtained from a standard non-windowed approach. Validation was performed using a resampling approach in which we demonstrate a 10% reduction of false positives from 2.5 million analyses. We applied the method to our production analysis pipeline that establishes genotype-phenotype associations by comparing mutant versus control data. We report an increase of 30% in significant P-values, as well as linkage to 106 versus 99 disease models via phenotype overlap with the soft-windowed and non-windowed approaches, respectively, from a set of 2082 mutant mouse lines. Our method is generalizable and can benefit large-scale human phenomic projects such as the UK Biobank and the All of Us resources. AVAILABILITY AND IMPLEMENTATION: The method is freely available in the R package SmoothWin, available on CRAN http://CRAN.R-project.org/package=SmoothWin. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group